How do you pick a therapist?

[Elizabeth Ann]

My wife and I have concluded that we need some counseling. The crossdressing thing is only a contributing factor. More significant is depression, sexual dysfunction, alienation, and a desperate desire between two people who love each other very much to regain the pleasure of each other's company. I want to shed some unfocused anger and quit staring at the ceiling at 3 a.m. Several hard knocks in the last few years have left my wife somewhat afraid of the risks of life. We both treasure our 30+ years together and don't want to endanger that.

My question is how does one pick a therapist? Do we simply pick one from the approved list of our health insurance? What questions do we ask of them? Do people normally interview potential therapists? From where do you get referrals? What kind of qualifications do you look for? What difference does it make if it is a man or a woman? What kind of specialties do they have, and if so, how to choose among them? Help!

Geez, this is so frustrating and anxiety producing. Since I can't find the therapist section in Consumer Reports, you guys are one of the few places I can think to ask.

Thanks,
Elizabeth

[Sharon]

I had a therapist about ten years ago who was highly recommended by someone who I very much respected, but who proved to be entirely wrong for me, personality conflicts not being the least of the problems. The thing is, I don't think there is a perfect way to choose a therapist, although I would definitely pay attention and weigh negative opinions.

I think the only way to find a therapist is to, first, find out if they are qualified (i.e. a degree, an ongoing and established practice), and, second, then meet and chat to see if you feel comfortable with them. If not, then try another.

[Debutante]

My wife is a therapist, and I have seen therapists over the years.
1. Don't have the therapist apply thru insurance companies with
the gender dysphoria code. Keep that private and off the books.
2. Yes -- deal with other issues.... they are real and need your attention.
3. crossdressing is a small part of things, but may be a big issue between couples. Don't make it the SOLE focus, because often it is not.
4. Deal with depression and other deeper issues... that's where the
problems lie...

[VtVicky]

Let me start by saying that it is refreshing to have someone actually looking for advice on how to choose a therapist.

Over 30+ years of practice, most of my patients came to me or my staff by way of a referral from their personal physician, a friend or relative, or their insurance company. However, none of those sources really had a very good idea what the patient needed because the patient only presented a superficial review of some of the symptoms. Very few people go into detail about why they want to find a therapist with someone other than a therapist. If, for example, crossdressing is an issue in marital problems or depression, very few people are going to tell the person they are asking for help finding a therapist that experience with gender disorders may be needed. Or, conversely, a focus on the crossdressing may overlook a need for someone with experience with substance abuse or psychopharmacology.

Perhaps I can provide some ideas where to start.

First, do you want a therapist or a counselor? A counselor is someone who is trained to help you get somewhere you are asking to go. A marriage counselor generally will help you work on improving your marriage, for example. A school counselor will be trained to help you take the right courses to get you into the college of your choice.

A therapist, on the other hand, is more likely to ask why, or if, you want to save your marriage. What does it mean to you in relation to your personal history and future plans and expectations. What, for example, in your academic history and experiences suggests that you will meet your long term goals by going to Harvard and studying medicine. Do you even have any long term goals identified.

Pastoral counselors most often have a base in a particular faith and moral code. Which can be helpful if your problems are a function of a crisis in your faith. A therapist will be careful to remain neutral and provide no moral judgements about your situation. Instead, asking how your behavior fits in with your own personal moral code.

There are hundreds of different types of counselors having a wide variety of skills, training, and techniques. And anyone of them may or may not be compatible with your situation. However, at least here in the States, most are not going to be covered by insurance. You should always find out what your insurance covers before starting anything. Decent treatment can take years and is seldom cheap. Also, look into what sorts of counselors are certified or licensed by your state or province. A certificate hanging on a wall from a prestigious sounding agency may or may not be worth anything, either. I can not tell you how many times over the years I have been solicited by some outfit that wanted to give me some recognition or certification if I simply paid the "administration" fee.

In my experience, there are four kinds of therapists that are pretty universally reimbursed by insurance companies. (But again, check with your company first.)

Psychiatrists. These are medical physicians (MD's) who have specialized in mental illnesses. They are the only mental health practitioners that can prescribe medications. Most, but not all, focus their practices on the kinds of mental illnesses that respond to psychotropic medications. (The major exception are the psychoanalysts. These are physicians who have had extensive training in psychoanalysis. While they are licensed to prescribe medications, most rely on "talk therapy"... an intensive exploration of your background and motivations.) You would consult a psychiatrist for major depression, (not necessarily "feeling blue" or sad over a recent loss, for example), suicidal ideation, difficulties with reality testing, (such as hearing voices, or seeing things that other people don't see.) or extreme, or uncontrollable, mood swings. (there are other reasons. But, those seem to be the most common.)

Clinical Psychologists. These therapist generally have a Doctorate in Psychology (PhD, or PsyD). Although some states license some psychologists at the Masters Degree level. These therapist often use behavioral therapy techniques as well as exploring your history and motivations. They are the profession most likely to use psychological testing in arriving at a diagnosis and treatment plan.

Clinical Social Workers. These therapist will have a Masters Degree in Clinical Social Work (Usually an MSW) They, too, will be Licensed or Certified by their state after their formal education and a number of years of supervised practice. (Usually, LICSW, LCSW, or CSW, depending on the state.) They generally focus their practices on interpersonal relationships and the emotional struggles coming from dysfunctions in this area. A large percentage of the people working with families and children are MSW's. They will generally be experienced in working with depression and other chronic mental illness. But, they will work with a physician, (sometimes a psychiatrist or sometimes the patients family physician), to coordinate any needed medications.

Psychiatric Nurses These are Nurses who have had extensive post graduate training in psychiatry. Although varying a bit from state to state, they will generally have the designation "RN MS CS" after their names. (It stands for Registered Nurse, Master of Science, [as in Masters Degree], Clinical Specialist.). They also may sub-specialize in adults or children. The ones that have worked for me have been some of the best therapists I have ever seen regardless of degrees or certification. They are generally better versed in the management of psychotropic medications than Clinical Psychologists or Clinical Social Workers. And are therefore better suited for the long term management of the chronically mentally ill. They do not prescribe medications, but are trained in administering and adjusting, (titrating), the meds, and observation of side effects.

These are the general groups. Within each group are dozens of specialists and great people. However, nothing will work if you are not comfortable with the individual, regardless of qualifications.

If you live in an area where you have the luxury of several to choose from, I would suggest that you call several to make an appointment to meet them and discuss your case. Explain on the phone that you are looking for treatment and that you are interviewing several potential therapists to look for a good therapeutic fit. And then, when you meet someone who you think would work, do not make the decision while you are sitting in his/her office. Wait until you get home. There is an atmosphere in a therapist's office that can be sort of seductive. It is meant to be relaxing and comfortable. Wait until you are out of that atmosphere, reflect on your reaction to the individual, and then decide whether or not to call for another appointment.

There are lots of other factors, but this posting is getting way too long. If you have any other questions, feel free to contact me. I'll try to answer them.


Good luck

[Kate Simmons]

I chose mine based on recommendations of the EAP (employee assistance program) co-ordinater at work. Once he assessed what some of my issues were, he gave me the names of local counselers in my area. My choice turned out to be a very good one and that particular therapist helped me a lot.:happy:

[Miss Petra]

Here is a great link for gender therapists.

I hope it helps.

http://www.lauras-playground.com/gender_therapists.htm

There is also a link there for international therapists as well.

Petra

[Jennaie]

I hate to say this but i think that I would pick the one that pissed me off the most. This is the person that challenged me but did not make me feel less of a person for having a different view than he/she/did.

If you pick a person who is in agreement with you always, what have you gained? nothing. It's the person who makes you think and challenges your cognitive schema that you learn from.

[Stephanie-L]

I found my current therapist through the "Psychology Today" website. The have a search engine where you can look for therapists who deal with the issues you are having problems in. I looked for one who deals with marriage issues as well as gay/lesbian issues since I felt that they would have a better chance of understanding transgender issues. The website does not specifically address gender issues. I then emailed and asked if she dealt with crossdressing and transgender issues, which she does. I go to my second meeting with her tomorrow and so far things seem good. The only downside is that she does not accept any insurance. Good luck on finding a therapist, and don't hesitate to switch to a different person if the first one doesn't click.....Stephanie

[KimberlyS]

My wife and I have had ours, hers, mine, and ours counselors. Do research on what they specialize in. But sometimes finding the right counselor is trial and error. A good counselor will tell you if you can not relate to them and open up to them, than they are not the right person for you.

For a joint counselor, after 1 or 2 sessions you both must be able to relate to and feel comfortable with them. Otherwise look for a different one.

TG Gender experience is a plus but not needed. And I do know of one case where the counselor having TG experience actually made things worse.

Try to focus on improving communicating with each other.

An individual counselor for each of you is a plus to vent and deal with personal issues.

One thing that helped us a lot was we always talked about the session afterwards. Sometimes more detailed, some times less. We called them our after the session sessions. The would last from 15 minutes to a couple of hours.

Jennaie, interesting that you said that. My wife and I ended up going to Christian based counselors. I know bad idea, but at the time I did not have a choice. I knew it would be an up hill battle and was. But interestingly the counselor helped me mostly with the personal issues and I was really forced to seriously look at the CDing things on my own. My counselor learned a lot about CDing through our sessions as I challenged a lot of her thoughts and then came later with examples of where I was coming from and how the stereo types she was going from were wrong.

[Susan.]

I had a shrink who was highly recommended and talking to her helped get things off my chest. I always giddy with anticipation for my sessions, I liked them very much. My wife has never wanted to listen or learn about crossdressing and I finally had someone to talk to.

The therapist was a bit liberal and said she would recommend me for hormones, which I didn't even want. Thought the idea, as a fantasy, was exciting. In my last session before I moved away, I brought in my wife. I was totally dis-illusioned because it was like my therapist flip flopped as she agree with everything my wife said. But I'd do it again in a hearbeat.

Anyway, she was in the book for general and gender counselling and that is how I found her, in the book.